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SBCP Pathology > GUT: Renal Disease > Flashcards

GUT: Renal Disease Flashcards

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1
Q

Congenital structural, non-neoplastic kidney diseases?

A

PKD
Agenesis
Horseshoe kidney
Abnormal ureteric systems

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2
Q

3 causes of obstructive hydronephrosis?

A

Extrinsic (eg lymph node)
Tumour in ureter wall
Stones

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3
Q

What can cause a staghorn calculus?

A

Proteus, or sometimes e coli, infection.

Staghorn calculus is molded by the luminal cavity of the pelvis and calyces over time.

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4
Q

Organisms causing acute pyelonephritis

A

May be bloode borne

E COLI MOST COMMON

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5
Q

Histology of pyelonephritis: Collections of _____ polymorphs. Grossly you can see small, studded ___ right through the renal parenchyma

A

Neutrophil

Abcesses

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6
Q

What needs to be present to define pyelonephritis as chronic?

A

POLAR SCARS involving the CALYX

Due to repeated infections

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7
Q

Histology of chronic pyelonephritis: Inflammation fibrosis, glom. sclerosis. And _____ of the tubules which contain a pink cast like material.

A

Thyroidisation (the pink casts resemble thyroid follicles)

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8
Q

Gross pathology of chronic pyelonephritis: Cystic appearing structures that are actually dilated _____. Renal parenchyma between these show a reduction in tissue.

A

Calyces

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9
Q

What percent of the population are born with one kidney?

A

1%, agenesis

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10
Q

Symptoms of PKD

A

Presents in 3rd decade

HTN
Renal masses
Chronic renal impairment

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11
Q

Complications of PKD

A

Cyst rupture or bleeding

10% develop cystic clear cell carcinoma

Liver and pancreas cysts

BERRY ANEURYSMS

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12
Q

Inheritance pattern of PKD

A

Autosomal dominant

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13
Q

Inheritance pattern of infantile PKD

A

Autosomal recessive

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14
Q

Prognosis of infantile PKD?

A

Very poor, severely impaired kidney function requiring dialysis from birth

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15
Q

Is a renal adenoma benign or malignant?

A

Benign

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16
Q

Is an oncocytoma benign or malignant?

A

Benign, but larger and very difficult to differentiate from a renal cancer so are often removed.

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17
Q

Is a metanephritic adenoma benign or malignant?

A

Benign, rare and often found incidentally

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18
Q

Examples of malignant tumours from the Heidelberg classification (6)

A
  • Clear cell carcinoma
  • Papillary carcinoma
  • Chromophobe carcinoma
  • Collecting duct carcinoma
Renal carcinoma unspecified
Urothelial tumours (TCC)
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19
Q

Name the four most common types of renal cancer

A

Clear cell carcinoma
Papillary carcinoma
Chromophobe carcinoma
Collecting duct carcinoma

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20
Q

What percentage of renal cancers are Clear cell?

A

75%

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21
Q

Are renal tumours more common in M or F?

A

M>F (2:1)

Associated with smoking

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22
Q

When do renal tumours present?

A

5th decade

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23
Q

Risk factors for renal tumours?

A

Tuberous sclerosis
Von Hippel-Lindau disease
Renal transplants
DIALYSIS due to scarring

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24
Q

Molecular pathology: Which cancer is linked to 3p del?

A

Clear cell

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25
Molecular pathology: Which cancer is linked to trisomy 7 and 17?
Papillary carcinoma
26
***Triad of renal cancer symptoms***
Mostly discovered incidentally, the clinical triad is rare - Renal mass - Haematuria - Flank
27
First line investigation for renal cancer?
CT scan
28
Clear cell carcinoma histology: Sheets of ___cells. Vacuolated cytoplasm. Pyknotic ___. Cystic in ___.
Clear Nuclei 15
29
Gross appearance of clear cell carcinoma: pale ____ (colour), tumour with areas of haemorrhage and cystic change in ___%
Yellow | 15
30
In what % of cases is a papillary CA bilateral?
10% therefore always check other kidney
31
Histology of chromophobe CA: Very ___cell membrane. Also perinuclear ____
Thick Halos
32
What is prognosis of collecting duct CA?
Very poor Very aggressive tumour, even when small, found in renal medulla
33
Which grading system is used for renal CAs?
Fuhrman grading, based on exclusively on NUCLEAR SIZE From I to IV
34
Stage pt1 of renal cancer
Confined to kidney, <7cm diameter
35
Stage pt2 of renal CA
Confined to kidney, >7cm
36
Stage pT3 of renal CA
Renal vein or vena cava involved
37
Stage pT4 of renal CA
Spread to adjacent organs or Gerota's fascia
38
Treatment options for renal RA
Radical nephrectomy Partial nephrectomy Radiofrequency ablation for small tumours Chemotherapy for metastasis (no benefit for renal tumour) Interferon
39
What is a radical nephrectomy?
Removing whole kidney, portion of ureter, adrenal gland, and any higher lymph nodes
40
Prognosis of pT1 renal CA?
70% 5 year survival
41
Prognosis of pT4 renal CA?
5%
42
How does Transitional cell carcinoma present in the kidney?
Cauliflower tumour involving the renal pelvis. More common in bladder/ ureters. Need to remove ureter in TCCs due to high risk of spread.
43
Another name for Wilms tumour?
Nephroblastoma Can be bilateral
44
Who presents with WIlms tumour? How does it present?
2-4 yr olds Usually abdominal mass rather than other symptoms. Then it has got a stromal component that sometimes can form muscle and cartilage prognosis has improved considerably, with improved surgical technique and chemotherapy in these cases, you would expect a cure, providing there is not a sort of anaplasia within the tumour.
45
How is glomerulonephritis classified? Clinically or pathologically
Mostly classified based on clinical features
46
What is Goodpasture's?
An anti-glomerular basement membrane disease (glomerulonephritis)
47
5 categories of presentation of glomerulonephritis?
Nephrotic syndrome (protein loss in urine) Nephritic syndrome Acute renal failure Chronic renal failure Incidental finding eg on dipstick
48
What level of proteinuria indicates nephrotic syndrome?
>3.5g in 24 hours
49
Classical features of nephrotic syndrome (4)
Proteinuria >3.5g in 24 hours Oedema Hypercholesterolaemia Hypoalbuminaeia
50
Main cause of nephrotic syndrome in adults?
Membranous glomerulonephritis
51
Clinical features of nephritic syndrome? (4)
Haematuria Renal impairment Hypertension **ACTIVE URINE SEDIMENT**
52
Histological signs of nephritis?
Proliferation of cells within glomeruli
53
Most common cause of pimary glomerulonephritis?
IgA nephropathy Presents as chronic renal failure in young men with nephrotic syndrome Very poor renal prognosis
54
Which primary glomerulonephritis causes nephrotic syndrome in children?
Minimal change disease
55
Is post-streptococcal GN a primary or secondary GN?
Primary Rarely biopsied but has good outcome
56
Most common time of year to see Goodpasture's disease?
Spring
57
Which primary glomerulonephritis is caused by lupus nephritis, hep C, cryoglobulinaemia etc?
Membranoproliferative GN
58
Gold standard test for diagnosing glomerulonephritis?
Renal biopsy under USS guidance
59
Why are 2-3 cores taken during a renal biopsy?
One for light microscopy One for immunofluorescence One for electron microscopy
60
What tissue is seen with Masson's trichrome stain in histology?
Connective
61
What is silver stain used for in renal histology?
To look at basement membrane
62
What is periodic acid-Schiff (PAS) stain used for?
TO detect glycogen deposits eg in hyperglycaemia
63
Which antibodies are applied to frozen tissue in immunofluorescence? (kidney)
IgG, A and M Complement (C3, C4, C1q) Fibrin
64
What is electron microscopy used for in renal histology?
Can identify deposits along the BM. Can also detect structural problems
65
True/false: In minimal change disease glomerulonephritis fusion of podocyte foot processes is seen at electron microscopy
True

SBCP Pathology (24 decks)

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